Table 1. Summary of clinical practice guidelines recommended steps in the management of children with severe anemia and the critical items used to determine adherence to guidelines.

Domain	Itemized CPG# recommended best practices steps	Required critical key items used in this study*
Assessment	Documented severe palmar pallor
	Triage: Assessed by clinician within 30–60 minutes of arrival to hospital
	Weight of child measured and recorded
Classification	Hemoglobin (Hb) level measured.
	Diagnosis of SA confirmed if Hb ≤ 5.0 g/dl	Pre-transfusion Hb ≤ 5 g/dl
Treatment	Blood transfusion given promptly within 2–4 hours of request if indicated.	Received a blood transfusion within 4 hours of request
	Blood given appropriately if indicated Dose: Packed cells 10 ml/kg or whole blood 20ml/kg given over 2–4 hours
Follow up (post-transfusion care)	Cause of SA investigated–(malaria tests, complete blood count, iron studies etc)	Relevant laboratory investigations done
	Specific treatment for cause of SA (antimalarials, antibiotics, hematinics, etc)	Received treatment for the cause of SA
	Pre-transfusion Hb done (repeat transfusion if Hb < 5 g/dl).
	Hematinics given post-transfusion

Note

^# CPG = Clinical Practice Guidelines

* a patient was required to have achieved in all the key critical domains to be considered to have been managed according to clinical guidelines.